A Multiplex RT-PCR Method for the Detection of Reptarenavirus Infection

Reptarenaviruses cause Boid Inclusion Body Disease (BIBD), a fatal disease of boid snakes with an economic and ecological impact, as it affects both captive and wild constrictor snakes. The clinical picture of BIBD is highly variable but often only limited. Intracytoplasmic inclusion bodies (IB), which develop in most cell types including blood cells, are the pathognomonic hallmark of BIBD; their detection represents the diagnostic gold standard of the disease. However, IBs are not consistently present in clinically healthy reptarenavirus carriers, which can, if undetected, lead to and maintain the spread of the disease within and between snake populations. Sensitive viral detection tools are required for screening and control purposes; however, the genetic diversity of reptarenaviruses hampers the reverse transcription (RT) PCR-based diagnostics. Here, we describe a multiplex RT-PCR approach for the molecular diagnosis of reptarenavirus infection in blood samples. The method allows the detection of a wide range of reptarenaviruses with the detection limit reaching 40 copies per microliter of blood. Using 245 blood samples with a reference RT-PCR result, we show that the technique performs as well as the segment-specific RT-PCRs in our earlier studies. It can identify virus carriers and serve to limit reptarenavirus spreading in captive snake collections.

A survey by the European Society of Breast Imaging on radiologists' preferences regarding quality assurance measures of image interpretation in screening and diagnostic mammography

OBJECTIVES

Quality assurance (QA) of image interpretation plays a key role in screening and diagnostic mammography, maintaining minimum standards and supporting continuous improvement in interpreting images. However, the QA structure across Europe shows considerable variation. The European Society of Breast Imaging (EUSOBI) conducted a survey among the members to collect information on radiologists' preferences regarding QA measures in mammography.

MATERIALS AND METHODS

An anonymous online survey consisting of 25 questions was distributed to all EUSOBI members and national breast radiology bodies in Europe. The questions were designed to collect demographic characteristics, information on responders' mammography workload and data about QA measures currently used in their country. Data was analysed using descriptive statistical analysis, the χ2 test, linear regression, and Durbin-Watson statistic test.

RESULTS

In total, 251 breast radiologists from 34 countries completed the survey. Most respondents were providing both screening and symptomatic services (137/251, 54.6%), working in an academic hospital (85/251, 33.9%) and reading 1000-4999 cases per year (109/251, 43.4%). More than half of them (133/251, 53%) had established QA measures in their workplace. Although less than one-third (71/251, 28.3%) had to participate in regular performance testing, the vast majority (190/251, 75.7%) agreed that a mandatory test would be helpful to improve their skills.

CONCLUSION

QA measures were in place for more than half of the respondents working in screening and diagnostic mammography to evaluate their breast imaging performance. Although there were substantial differences between countries, the importance of having QA in the workplace and implemented was widely acknowledged by radiologists.

CLINICAL RELEVANCE STATEMENT

Although several quality assurance (QA) measures of image interpretation are recommended by European bodies or national organisations, the QA in mammography is quite heterogenous between countries and reporting settings, and not always actively implemented across Europe.

KEY POINTS

The first survey that presents radiologists' preferences regarding QA measures of image interpretation in mammography. Quality assurance measures in the workplace are better-established for breast screening compared to diagnostic mammography. Radiologists consider that performance tests would help to improve their mammography interpretation skills.

A comparison of breast screening performance based on a standardised test, during and outside of the COVID-19 lockdown period

PURPOSE

In the UK, the COVID-19 pandemicand the resulting lockdown significantly impacted routine breast screening and led to reduced case volumes for breast screening readers. The aim of the study was to evaluate whether breast screening performance on a test-set based assessment scheme (PERFORMS) varied over time, in association with the lockdown period.

METHOD

In this retrospective study, performance data were obtained for all breast cancer screening readers in England who completed the PERFORMS schemes based on digital mammography (from 2015 to 2022). Cancer detection (sensitivity), correct return to screen (specificity) and the difference between the sensitivity and specificity were calculated for each breast screener in each PERFORMS scheme.

RESULTS

During the study period, 4906 readers participated in eight PERFORMS schemes. Both the cancer detection (H(7) = 775.56, p <.00001) and correct return to screen rate (H(7) = 401.13, p <.00001) varied significantly by scheme. The difference between cancer detection and correct return to screen rate in the scheme administered during the lockdown period was significantly higher than in all other schemes (p <.05, Bonferroni correction applied).

CONCLUSIONS

The performance of breast screeners on the PERFORMS test-set based assessment scheme which was administered during the lockdown period, was characterised by markedly high sensitivity and low specificity when compared to their performance on other tests taken pre-COVID and following the lockdown.

Artificial intelligence in breast imaging: Current situation and clinical challenges

Breast cancer ranks among the most prevalent malignant tumours and is the primary contributor to cancer-related deaths in women. Breast imaging is essential for screening, diagnosis, and therapeutic surveillance. With the increasing demand for precision medicine, the heterogeneous nature of breast cancer makes it necessary to deeply mine and rationally utilize the tremendous amount of breast imaging information. With the rapid advancement of computer science, artificial intelligence (AI) has been noted to have great advantages in processing and mining of image information. Therefore, a growing number of scholars have started to focus on and research the utility of AI in breast imaging. Here, an overview of breast imaging databases and recent advances in AI research are provided, the challenges and problems in this field are discussed, and then constructive advice is further provided for ongoing scientific developments from the perspective of the National Natural Science Foundation of China.

Sweet Wine Production from the Side-Stream of Industrial Corinthian Currant Processing: Product Quality, Antioxidant Capacity, and Volatilome

In the frame of efforts to add value to the Mediterranean currant cultivation and processing sectors, which is essential for their sustainability, sweet wine production is proposed from the finishing side-stream (FSS) of premium quality Corinthian currants, involving complete fermentation using an alcohol-tolerant yeast followed by (i) the addition of FSS to extract sugars or (ii) syrup made from FSS to adjust sweetness. Wine was also made by (iii) ceasing fermentation at the desired sugar level by ethanol addition. The non-fortified wines had 15.2-15.5% ethanol, 115-145 g/L residual sugar, 7.2-7.6 g/L titratable acidity, low volatile acidity (VA; <0.33 g/L), 280-330 mg/L phenolic content (TPC) (as gallic acid), and 23.8-35.6 mg/L antioxidant capacity (AC) (as ascorbic acid). In total, 160 volatiles were identified by SPME GC-MS, including compounds derived from the grapes, the raisin drying, and the fermentation process. The non-fortified wines had better characteristics (mainly VA, AC, and TPC) than the fortified wine, while sweetness adjustment by FSS is the simplest and lowest cost method since it does not involve ethanol or syrup addition. The proposed methods can lead to good quality sweet wines with a characteristic fruity (grape/raisin) flavor that could be commercialized as specialty raisin beverages or liqueurs.

Reptarenavirus S Segment RNA Levels Correlate with the Presence of Inclusion Bodies and the Number of L Segments in Snakes with Reptarenavirus Infection-Lessons Learned from a Large Breeding Colony

Reptarenaviruses cause boid inclusion body disease (BIBD), a fatal disease particularly impacting captive boa constrictor collections. The development of cytoplasmic inclusion bodies (IBs) comprising reptarenavirus nucleoprotein (NP) in many cell types of affected snakes is characteristic of BIBD. However, snakes can harbor reptarenaviruses without showing IBs, hence representing carriers and a potential source of transmission. The RNA genome of reptarenaviruses comprises a small (S) and a large (L) segment, and the snakes with BIBD commonly carry a swarm of reptarenavirus segments. To design sensitive and reliable tools for the diagnosis of reptarenavirus infection in snake colonies, we used metatranscriptomics to determine the reptarenavirus segments present in a large boa constrictor breeding colony. The analysis identified one reptarenavirus S segment and three L segments in the colony. The sequence data served to design real-time reverse transcription-PCR (RT-PCR) targeting the found S segment. This allowed us to identify all infected animals and to quantify the S segment RNA levels, which we found to correlate with the presence of IBs. We further found a positive correlation between the number of L segments and the S segment RNA level, which could suggest that L segment excess also contributes to the IB formation. Information on cohousing of the snakes showed a clear association of reptarenavirus infection with cohousing in general and cohousing with infected animals. Information on breeding and offspring confirmed that vertical transmission occurred. Furthermore, our data suggest that some animals might be able to clear the infection or at least exhibit transient or intermittent viremia. IMPORTANCE Boid inclusion body disease (BIBD) is caused by reptarenavirus infection, and while reptarenavirus nucleoprotein is the main component of the inclusion bodies (IBs) characteristic of BIBD, not all reptarenavirus-infected snakes demonstrate IBs in their cells. Identification of infected individuals is critical for controlling the spread of the disease; however, the genetic divergence of reptarenaviruses complicates reverse transcription-PCR (RT-PCR)-based diagnostics. Here, we tested a next-generation-sequencing-based approach to establish a tailored "colony-specific" set of diagnostic tools for the detection of reptarenavirus small (S) and large (L) genome segments. With this approach, we could demonstrate that an S-segment-specific RT-PCR is highly effective in identifying the infected individuals. We further found the S segment RNA level to positively correlate with the presence of IBs and the number of L segments, which could direct future studies to identify the BIBD pathogenetic mechanisms.

Air pollution mitigation assessment to inform Cambodia's first clean air plan

Cambodia's 16.5 million people are exposed to air pollution in excess of World Health Organisation guidelines. The Royal Government of Cambodia has regulated air pollutant emissions and concentrations since 2000, but rapid economic growth and energy consumption means air pollution continues to impact human health. In December 2021, the Ministry of Environment of Cambodia published Cambodia's first Clean Air Plan that outlines actions to reduce air pollutant emissions over the next decade. This work presents the quantitative air pollution mitigation assessment underpinning the identification and evaluation of measures included in Cambodia's Clean Air Plan. Historic emissions of particulate matter (PM_2.5, black carbon, organic carbon) and gaseous (nitrogen oxides, volatile organic compounds, sulphur dioxide, ammonia, and carbon monoxide) air pollutants are quantified between 2010 and 2015, and projected to 2030 for a baseline scenario. Mitigation scenarios reflecting implementation of 14 measures included in Cambodia's Clean Air Plan were modelled, to quantify the national reduction in emissions, from which the reduction in ambient PM_2.5 exposure and attributable health burdens were estimated. In 2015, the residential, transport, and waste sectors contribute the largest fraction of national total air pollutant emissions. Without emission reduction measures, air pollutant emissions could increase by between 50 and 150% in 2030 compared to 2015 levels, predominantly due to increases in transport emissions. The implementation of the 14 mitigation measures could substantially reduce emissions of all air pollutants, by between 60 and 80% in 2030 compared to the baseline. This reduction in emissions was estimated to avoid approximately 900 (95% C.I.: 530-1200) premature deaths per year in 2030 compared to the baseline scenario. In addition to improving air pollution and public health, Cambodia's Clean Air Plan could also to lead to additional benefits, including a 19% reduction in carbon dioxide emissions, simultaneously contributing to Cambodia's climate change goals.

Haematology, biochemistry and morphological features of peripheral blood cells in captive Boa constrictor

The common boa (Boa constrictor) belongs to the family Boidae and represents one of the most popular traded and kept snake species in captivity. The early diagnosis, prevention and prophylaxis of diseases in this species, and in reptiles in general, still pose major challenges, also due to the lack of reliable reference values. This prompted us to conduct a study on clinically healthy captive B. constrictor to assess their basic health parameters in the blood (haematological and biochemical values, stress markers). Several parameters differed significantly between younger (<3 years) and older (≥3 years) boas; in the latter, the percentages of eosinophils, the haemoglobin and haematocrit levels, as well as the albumin and total protein levels, were higher. In male snakes, cholesterol levels were significantly higher than in females. Light and electron microscopy as well as immunohistochemistry served to identify and determine the morphological features of peripheral blood cells, that is, heterophils, basophils, eosinophils, azurophils, monocytes, lymphocytes, thrombocytes and erythrocytes. Leukocyte subpopulations, that is, T and B cells and monocytes, were also identified based on specific marker expression. The study provides data on haematological, biochemical and stress hormone levels, suitable as reference values, and on the blood cell morphology of B. constrictor which can serve as a guideline for further research on this species.

Performance of Radiologists and Radiographers in Double Reading Mammograms: The UK National Health Service Breast Screening Program

Background Double reading can be used in screening mammography, but it is labor intensive. There is limited evidence on whether trained radiographers (ie, technologists) may be used to provide double reading. Purpose To compare the performance of radiologists and radiographers double reading screening mammograms, considering reader experience level. Materials and Methods In this retrospective study, performance and experience data were obtained for radiologists and radiographer readers of all screening mammograms in England from April 2015 to March 2016. Cancer detection rate (CDR), recall rate (RR), and positive predictive value (PPV) of recall based on biopsy-proven findings were calculated for first readers. Performance metrics were analyzed according to reader professional group and years of reading experience using the analysis of variance test. P values less than .05 were considered to indicate statistically significant difference. Results During the study period, 401 readers (224 radiologists and 177 radiographers) double read 1 404 395 screening digital mammograms. There was no difference in CDR between radiologist and radiographer readers (mean, 7.84 vs 7.53 per 1000 examinations, respectively; P = .08) and no difference for readers with more than 10 years of experience compared with 5 years or fewer years of experience, regardless of professional group (mean, 7.75 vs 7.71 per 1000 examinations respectively, P = .87). No difference in the mean RR was observed between radiologists and radiographer readers (5.0% vs 5.2%, respectively, P = .63). A lower RR was seen for readers with more than 10 years of experience compared with 5 years or fewer, regardless of professional group (mean, 4.8% vs 5.8%, respectively; P = .001). No variation in PPV was observed between them (P = .42), with PPV values of 17.1% for radiologists versus 16.1% for radiographers. A higher PPV was seen for readers with more than 10 years of experience compared with 5 years or less, regardless of professional group (mean, 17.5% and 14.9%, respectively; P = .02). Conclusion No difference in performance was observed between radiographers and radiologists reading screening mammograms in a program that used double reading. Published under a CC BY 4.0 license Online supplemental material is available for this article. See also the editorial by Hooley and Durand in this issue.

Integrated climate change and air pollution mitigation assessment for Togo

Togo, in west Africa, is vulnerable to the impacts of climate change, but has made a negligible contribution to causing it. Togo ratified the Paris Agreement in 2017, committing to submit Nationally Determined Contributions (NDCs) that outline Togo's climate change mitigation commitment. Togo's capital, Lomé, as well as other areas of Togo have ambient air pollutant levels exceeding World Health Organisation guidelines for human health protection, and 91 % of Togolese households cook using solid biomass, elevating household air pollution exposure. In Togo's updated NDC, submitted in 2021, Togo acknowledges the importance and opportunity of achieving international climate change mitigation targets in ways that improve air quality and achieve health benefits for Togo's citizens. The aim of this work is to evaluate priority mitigation measures in an integrated assessment of air pollutant, Short-Lived Climate Pollutant (SLCP) and Greenhouse Gas (GHG) emissions to identify their effectiveness in simultaneously reducing air pollution and Togo's contribution to climate change. The mitigation assessment quantifies emissions for Togo and Grand Lomé from all major source sectors for historical years between 2010 and 2018, for a baseline projection to 2030 and for mitigation scenarios evaluating ten mitigation measures. The assessment estimates that Togo emitted ~21 million tonnes of GHG emissions in 2018, predominantly from the energy and Agriculture, Forestry and Other Land Use sectors. GHG emissions are projected to increase 42 % to 30 million tonnes in 2030 without implementation of mitigation policies and measures. The implementation of the ten identified priority mitigation measures could reduce GHG emissions by ~20 % in 2030 compared to the baseline, while SLCPs and air pollutants were estimated to be reduced more, with a more than 75 % reduction in black carbon emissions in 2030. This work therefore provides a clear pathway by which Togo can reduce its already small contribution to climate change while simultaneously achieving local benefits for air quality and human health in Togo and Grand Lomé.

Differences in Left atrial stain, endothelial glycocalyx and arterial elasticity between ESUS, lacunar and atherosclerotic type of stroke

Funding Acknowledgements

Type of funding sources: None.

Background and Aims

Patients with stroke are at high risk to develop cardiovascular complications. We assessed endothelial glycocalyx, aortic elastic properties, left atrial and ventricular function in patients with lacunar, atherosclerotic and stroke of undetermined source (ESUS).

Patients and methods

In 75 patients (age 55.2 ± 10.6) with acute cerebral stroke (25 lacunar, 20 atherosclerotic and 30 ESUS) and 20 controls with similar risk factors, we measured: (1) perfused boundary region (PBR) of the sublingual arterial microvessels (range 5–25 µm), a marker inversely related with glycocalyx thickness, (2) pulse wave velocity (PWV), central systolic blood pressure (cSBP), and augmentation index (AIx), (3) Left atrial (LA) strain using speckle-tracking imaging, and (4) left ventricular global longitudinal strain.

Results

Compared with controls, patients with stroke had higher PWV (11.38 ± 3.62 vs 9.51 ± 1.57 m/sec, p = 0.045), PBR (2.10 ± 0.27 vs 1.94 ± 0.20, p = 0.039) and central SBP (139.64 ± 26.31 vs 116.36 ± 37.23 mmHg, p = 0.039), while ventricular (-17.902 ± 3.77 vs - 19.87 ± 1.17%, p = 0.025) and atrial deformation (24.8 ± 9.99 vs 39.05 ± 2.08%, p &lt; 0.001) were impaired in patients with stroke (p &lt; 0.05).

LA reservoir strain was more reduced in ESUS patients compared to other 2 stroke types (ESUS 21.7 ± 6.6%, Lacunar 25.6 ± 13.2%, atherosclerotic 22.3 ± 7.8%, P &lt; 0.05).

Regarding endothelial glycocalyx, PBR5-9 (the smallest vessels with diameter 5-9 μm) was higher in patients with ESUS than in the other two types of stroke (ESUS 1.22 ± 0.12 μm, LACUNAR 1.19 ± 0.12 μm, ATHEROSCLEROTIC 1.15 ± 0.09 μm, p &lt; 0.05), despite the fact that PBR5-25 was similar between all stroke types (ESUS 2.09 ± 0.23 μm, LACUNAR 2.13 ± 0.33 μm, ATHEROSCLEROTIC 2.09 ± 0.24 μm, p = 0.8).

PWV was significantly higher in patients with atherosclerotic stroke (15.57 ± 5.50 m/sec, p = 0.007), while in patients with lacunar it was mildly elevated (10.53 ± 3.22 m/sec) and in ESUS patients it was moderately increased (11.7 ± 3 m/sec).

Conclusions

Patients with stroke have impaired atrial strain, endothelial glycocalyx and arterial elasticity, compared with controls. Arterial stiffness is more affected in atherosclerotic stroke, while LA deformation and glycocalyx of small size micro vessels are more affected in ESUS patients.

Translation and validation of an ageism scale for dental students in Switzerland

PURPOSE

This study aimed to validate an ageism scale for dental students in Switzerland.

METHODS

The original scale was first translated to German and then evaluated by 14 experts for relevance; four items were eliminated. Validation of the resulting questionnaire was performed at three Swiss dental schools. Principal component analysis (PCA) was performed; Cronbach's alpha (α) was used to assess the internal consistency reliability, and Pearson's coefficient to identify any correlations with demographic parameters (P < 0.05).

RESULTS

PCA revealed 11 items among 4 factors (Overall: 11 items, α = 0.63, variance = 56.6%; Factor #1 (F1): items = 3, α = 0.64; Factor #2 (F2): items = 3, α = 0.42; Factor #3 (F3): items = 3, α = 0.35; Factor #4 (F4): items = 2, α = 0.37). F1 and F4 were correlated with clinical experience (F1: P = 0.042; F4: P = 0.006) and participation in a gerodontology course (F1: P = 0.021; F4: P = 0.004). F1 was correlated with experience of dealing with the elderly (P = 0.031), while residence locality was correlated with F3 (P = 0.047) and F4 (P = 0.043). F2 was correlated with the presence of elderly in the family (P = 0.047).

CONCLUSION

The translated dental ageism questionnaire for Switzerland resulted in an 11-item scale with acceptable reliability.

The midterm differential effects of heat-not-burn and conventional cigarettes on coronary flow, vascular function and oxidative stress are independent of nicotine levels

Introduction

Heat-not-burn cigarette (HNBC) constitutes a non-combustible smoke product linked to reduced exposure to carbon monoxide (CO).

Methods

We compared the effects of HNBC to those of tobacco cigarette (TCig) on endothelial and coronary function as well as on nicotine levels, oxidative stress and platelet activation after 1 month of switching to HNBC.

We examined 75 smokers. Of those, 50 were switched to HNBC and 25 continued Tcig for 1 month.

At baseline and at 1 month, we assessed a) coronary flow reserve (CFR) by echocardiography b) flow-mediated dilation (FMD) c) Cotinine blood levels, a stable metabolite of nicotine d) malondialdehyde (MDA), a marker of oxidative stress and thromboxane B2 (TXB2), a marker of platelet activation e) the exhaled CO and the number of cigarettes and/or heat stick of HNBC used. Fagerstrom score, a marker of dependence from smoking habit was also calculated.

Results

Compared to Tcig smoking, switching to HNBC for 1-month improved CO (difference in CO between groups: 10.42 ppm; 95% CI 3.07 to 17.76, p=0.007), FMD (difference in FMD=4.3%; 95% CI: 1.23 to 7.51, p=0.009; and CFR (difference in CFR =0.98; 95% CI: 0.23 to 1.80, p=0.02). MDA and TXB2 concentration significantly decreased in subjects switching to HNBC compared to tobacco smokers (difference MDA=0.38 nmol/L; 95% CI 0.10 to 0.66, p=0.009, 45pg/mL; 95% CI 5.28 to 86.31, p=0.03). None of the aforementioned parameters changed in the control group at 1 month compared to baseline (p&gt;0.05).

Cotinine blood levels were similar between the TC cig and HNBC group both at baseline and after one month of use (p&gt;0.05). However, cotinine blood levels at baseline and 1 month correlated with the number cigarettes used at baseline (r=0.45 p=0.04) or the number of heat sticks used at one month (r=0.50, p=0.03) respectively, Baseline Fagerstrom score was also associated with number of heat sticks used at 1 month (r=0.48, p=0.04) and cotinine levels at baseline and at 1 month (p=0.50, p=0.03 and r=0.57, p=0.01 respectively).

Conclusions

HNBCs exert a less detrimental effect on vascular function platelet activation and oxidative stress than tobacco smoking that is independent of nicotine levels and is linked with the parallel reduction the exhaled of CO.

Funding Acknowledgement

Type of funding sources: None.

Differences in left atrial stain, endothelial glycocalyx and arterial elasticity between ESUS, lacunar and atherosclerotic type of stroke

Background and purpose

Patients with stroke are at high risk to develop cardiovascular complications. We assessed endothelial glycocalyx, aortic elastic properties, left atrial and ventricular function in patients with lacunar, atherosclerotic and stroke of undetermined source (ESUS).

Methods

In 68 patients (age 56,1±10.9) with acute cerebral stroke (22 lacunar, 19 atherosclerotic and 27 ESUS) and 20 controls with similar risk factors, we measured: (1) perfused boundary region (PBR) of the sublingual arterial microvessels (range 5–25 μm), a marker inversely related with glycocalyx thickness, (2) pulse wave velocity (PWV), central systolic blood pressure (cSBP), and augmentation index (AIx), (3) LA volume and strain using speckle-tracking imaging, and (4) left ventricular global longitudinal strain.

Results

Compared with controls, patients with stroke had higher PWV (11,38±3,62 vs 9,51±1,57 m/sec, p=0,045), PBR (2,10±0,27 vs 1,94±,020, p=0,039) and central SBP (139,64±26,31 vs 116,36±37,23 mmHg, p=0,039), while ventricular (−17,902±3,77 vs −19,87±1,17%, p=0,025) and atrial deformation (24,8±9,99 vs 39,050±2,08%, p&lt;0.001) were impaired in patients with stroke (p&lt;0.05).

LA reservoir strain was more reduced in ESUS patients compared to other 2 stroke types (ESUS 21,7±6,6%, Lacunar 25,6±13,2%, atherosclerotic 22,3±7,8%, P&lt;0.05).

Regarding endothelial glycocalyx, PBR5–9 (the smallest vessels with diameter 5–9 μm) was higher in patients with ESUS than in the other two types of stroke (ESUS 1,22±0,12 μm, LACUNAR 1,19±0,12 μm, ATHEROSCLEROTIC 1,15±0,09 μm, p&lt;0.05), despite the fact that PBR5–25 was similar between all stroke types (ESUS 2,09±0.23 μm, LACUNAR 2,13±0,33 μm, ATHEROSCLEROTIC 2,09±0,24 μm, p=0.8).

PWV was significantly higher in patients with atherosclerotic stroke (15,57±5,50 m/sec, p=0,007), while in patients with lacunar it was mildly elevated (10,53±3,22 m/sec) and in ESUS patients it was moderately increased (11,7±3 m/sec).

Conclusion

Patients with stroke have impaired atrial strain, endothelial glycocalyx and arterial elasticity, compared with controls. Arterial stiffness is more affected in atherosclerotic stroke, while LA deformation and glycocalyx of small size micro vessels are more affected in ESUS patients.

Funding Acknowledgement

Type of funding sources: None.

The relationship between missed breast cancers on mammography in a test-set based assessment scheme and real-life performance in a National Breast Screening Programme

PURPOSE

This retrospective study determined whether a test-set based assessment scheme (PERFORMS) used in a national breast screening programme could be used to predict real-life performance by investigating if the number of cancers missed by mammography readers in real-life related to the number of cancers missed in the PERFORMS test-set and whether real-life reading volumes affected performance.

METHOD

Data was obtained from consenting readers in the screening programme in England (NHSBSP) where double reading is standard. The rate of cancers missed by individual first readers but correctly identified by second readers was compared with the number of cancers missed in the PERFORMS test-set over a 3-year period. NHSBSP readers are required to interpret at least 1500 cases per year as a first reader, so results were compared between readers who exceeded this target and those that did not. Parametric and non-parametric correlations were calculated.

RESULTS

Amongst the 536 readers, there was a highly significant positive correlation between the real-life and PERFORMS test-set missed cancer metrics (Pearson Correlation = 0.228, n = 536, p < .0001, Spearman's rho = 0.265, n = 536, p < .0001). There was no significant difference in rates of missed cancers between the 452 readers who exceeded the 1500 first read per year target and those who did not (t(94.2) = -1.87, p = .0643, r = 0.19).

CONCLUSIONS

The use of a test-set based assessment scheme accurately reflects real-life mammography reading performance, indicating that it can be a useful tool in identifying poor reader performance.

Antibody response in snakes with boid inclusion body disease

Boid Inclusion Body Disease (BIBD) is a potentially fatal disease reported in captive boid snakes worldwide that is caused by reptarenavirus infection. Although the detection of intracytoplasmic inclusion bodies (IB) in blood cells serves as the gold standard for the ante mortem diagnosis of BIBD, the mechanisms underlying IB formation and the pathogenesis of BIBD are unknown. Knowledge on the reptile immune system is sparse compared to the mammalian counterpart, and in particular the response towards reptarenavirus infection is practically unknown. Herein, we investigated a breeding collection of 70 Boa constrictor snakes for BIBD, reptarenavirus viraemia, anti-reptarenavirus IgM and IgY antibodies, and population parameters. Using NGS and RT-PCR on pooled blood samples of snakes with and without BIBD, we could identify three different reptarenavirus S segments in the collection. The examination of individual samples by RT-PCR indicated that the presence of University of Giessen virus (UGV)-like S segment strongly correlates with IB formation. We could also demonstrate a negative correlation between BIBD and the presence of anti-UGV NP IgY antibodies. Further evidence of an association between antibody response and BIBD is the finding that the level of anti-reptarenavirus antibodies measured by ELISA was lower in snakes with BIBD. Furthermore, female snakes had a significantly lower body weight when they had BIBD. Taken together our findings suggest that the detection of the UGV-/S6-like S segment and the presence of anti-reptarenavirus IgY antibodies might serve as a prognostic tool for predicting the development of BIBD.

Inter-observer agreement for clinical examinations of foot lesions of sheep

In sheep, the diagnosis of foot lesions is routinely based on physical examination of the hoof. Correct diagnosis is important for the effective treatment, prevention and control of both infectious and non-infectious causes of lameness. Therefore, the aim of this study was to evaluate the level of inter-observer agreement for clinical examination of ovine foot lesions. Eight observers of varying experience, training and occupation performed foot examinations on a total of 1158 sheep from 38 farms across North England and Wales. On each farm, a group of two to four observers independently examined a sample of 24 to 30 sheep to diagnose the presence or absence of specific foot lesions including white line lesions (WL), contagious ovine digital dermatitis (CODD), footrot (FR), inter-digital dermatitis (ID) and toe granuloma (TG). The inter-observer agreement of foot lesion assessments was examined using Fleiss kappa (κ), and Cohen's κ examined the paired agreement between the test standard observer (TSO) and each observer. Scoring differences with the TSO were examined as the percentage of scoring errors and assessed for evidence of systematic scoring bias. With the exception of WL (maximum error rate 33.3%), few scoring differences with the TSO occurred (maximum error rate 3.3%). This suggests that observers can achieve good levels of reliability when diagnosing most of the commonly observed foot conditions associated with lameness in sheep.

Reliability of indicators of sheep welfare assessed by a group observation method

Assessments of animal-based outcomes form the core of routine veterinary clinical examinations and are being increasingly used as indicators of animal welfare. A method of group observation that did not require gathering and handling of individual sheep, was used to assess eight animal-based indicators of sheep welfare: demeanour, skin irritation, wool loss, excessive panting, coughing, lameness, and cleanliness of the ventral abdominal and 'breech' (perineum/gluteal/caudal hindlimb) areas. The inter-observer reliability of two or three observers who independently assessed these indicators was tested on 2406 adult sheep and growing lambs across 36 farms and the intra-observer reliability of an experienced, veterinary assessor--the 'test standard observer'--was assessed on 88 adult sheep during four on-farm assessments. Observer reliability was evaluated using Cronbach's alpha (α) comparison of the recorded proportion (%) of sheep affected by each welfare condition and by binomial logistic regression modelling. High levels of inter-observer reliability were identified for the assessment of group lameness (α 0.76-1.00) and cleanliness of the breech area (α 0.97-1.00). Excellent intra-observer reliability was determined for lameness (α 0.99), cleanliness of the breech area (α 0.97), demeanour (α 1.00) and wool loss (α 1.00). In addition, proportion data and logistic regression models identified few between-observer differences. The results suggest that welfare outcomes based on observations of the behaviour and physical appearance of individual animals within a group may offer a reliable and feasible measurement tool for the on-farm assessment of sheep welfare.

Detection of the genome of Chlamydophila abortus in samples taken from the uteri of 304 sheep at an abattoir

A PCR was used to detect the genome of Chlamydophila abortus in samples of uterine tissue collected from 304 sheep by a sterile technique at an abattoir. The stage of pregnancy of the sheep was determined by measuring the dimensions of the embryo/fetus, and its morphology was recorded. Only samples from non-pregnant sheep and sheep up to 100 days of gestation were retained; the clinical history of the animals was unknown. The total prevalence of the chlamydial genome was 30.9 per cent, with a significantly higher prevalence in the pregnant animals (46.9 per cent). Higher detection rates were recorded during early gestation than during mid-gestation.

Early pregnancy diagnosis in swine by direct radioimmunoassay for progesterone in blood spotted on filter paper

A direct radioimmunoassay method for the measurement of progesterone in blood dried on filter paper has been developed for the early pregnancy diagnosis in sows, as well as for monitoring progesterone levels during the oestrous cycle. Pregnancy diagnosis was performed with 95 sows on Days 17-22 after artificial insemination (AI). The cut-off value for pregnancy diagnosis of 7.5 ng/ml was calculated (mean+/-2S.D.) from the progesterone concentrations measured on the same days from non-inseminated animals. There were 85 cases considered pregnant on the basis of progesterone concentration, leaving 10 animals non-pregnant. The accuracy for the positive cases was 98.8%. Two of the 10 sows considered as negative subsequently farrowed, giving an accuracy of 80%. The overall accuracy of the method was 96.8%. The blood-spot assay may be a useful tool for early pregnancy diagnosis in swine, with respect to sampling, simplicity, speed and accuracy.

Descriptive epidemiology of the 2001 foot-and-mouth disease epidemic in Great Britain: the first five months

In February 2001, foot-and-mouth disease (FMD) was confirmed in Great Britain. A major epidemic developed, which peaked around 50 cases a day in late March, declining to under 10 a day by May. By mid-July, 1849 cases had been detected. The main control measures employed were livestock movement restrictions and the rapid slaughter of infected and exposed livestock. The first detected case was in south-east England; infection was traced to a farm in north-east England to which all other cases were linked. The epidemic was large as a result of a combination of events, including a delay in the diagnosis of the index case, the movement of infected sheep to market before FMD was first diagnosed, and the time of year. Virus was introduced at a time when there were many sheep movements around the country and weather conditions supported survival of the virus. The consequence was multiple, effectively primary, introductions of FMD virus into major sheep-keeping areas. Subsequent local spread from these introductions accounted for the majority of cases. The largest local epidemics were in areas with dense sheep populations and livestock dealers who were active during the key period. Most affected farms kept both sheep and cattle. At the time of writing the epidemic was still ongoing; however, this paper provides a basis for scientific discussion of the first five months.

Defective growth hormone secretion in primary microcephaly

The 24 hr variations of plasma growth hormone (GH) and/or GH secretion provoked by oral glucose load or by insulin-induced hypoglycemia were studied in five microcephalic children. Low levels of GH and, especially, complete lack of secretory episodes were detected in three of the five children, two of whom were brothers. GH deficiency may constitute the principal or a contributing factor of impaired growth in some microcephalic children. A possible association between the cerebral abnomality and the pituitary hypofunction is suggested. An analogy is made between the present cases and the neuroendocrine complexes reported as Kallmann's and de Morsier's syndromes, respectively.